Provider Demographics
NPI:1457563843
Name:MAXFIELD, BRETT BUCKLEY (RN)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:BUCKLEY
Last Name:MAXFIELD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 MOONSTONE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2411
Mailing Address - Country:US
Mailing Address - Phone:208-709-3295
Mailing Address - Fax:
Practice Address - Street 1:1293 MOONSTONE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2411
Practice Address - Country:US
Practice Address - Phone:208-709-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-34179163W00000X, 163WC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program